December 10, 2019
USPSTF Issues Final Recommendation Statement on Screening for AAA
December 10, 2019—The US Preventive Services Task Force (USPSTF) published a final recommendation statement on screening for abdominal aortic aneurysm (AAA) in those who do not have signs or symptoms of AAA. Based on the evidence, the USPSTF recommendation on screening for AAA varies depending on sex, age, smoking status, and family history.
The Task Force’s final recommendation statement and corresponding evidence summary are available on the Task Force website here and were published in Journal of the American Medical Association (2019;322:2211–2218).
In the announcement, USPSTF member Michael J. Barry, MD, commented, “Screening can reduce AAA-related death, rupture, and emergency surgery. The evidence shows that older men who are current or past smokers benefit the most from screening and should be screened. Older men who have never smoked might also consider screening.”
Task Force member Chyke A. Doubeni, MD, added, “The Task Force found that women who have never smoked and have no family history of AAA have a very low chance of having AAA and should not be screened because the evidence shows it could be harmful. However, for women who have ever smoked or who have a family history of AAA, more research is needed to determine if screening is beneficial.”
The USPSTF advised that grades in this recommendation are, "B: Recommended; C: The recommendation depends on the patient’s situation; D: Not recommended; I: The balance of benefits and harms cannot be determined."
According to the announcement, the key recommendations are the following:
- Men who are 65 to 75 years old and smoke or used to smoke are the group that benefits the most from screening for AAA. The USPSTF recommends these men be screened once, using ultrasound, to help prevent a rupture. This is a B recommendation.
- Men who are 65 to 75 years old and have never smoked should make the decision to screen individually in consultation with a clinician. Clinicians should take into account the man’s medical history; risk factors such as heart disease, high blood pressure, and history of other aneurysms; and his personal values and preferences. This is a C recommendation.
- Women who have never smoked and do not have a family history of AAA should not be screened for AAA. Women are significantly less likely to have AAA and have a higher risk of harm from treatment of the aneurysm than men. Treatment can lead to major surgeries that may be unnecessary, harmful, and potentially cause death. This is a D recommendation.
- Women who are 65 to 75 years old and are current or past smokers or have a family history of AAA may or may not be screened based on the judgment of their clinician. The USPSTF concludes that there is not enough evidence to recommend for or against screening for AAA. This is an I statement.